Knowledge and attitudes of postpartum women toward immunization during pregnancy and the peripartum period

Abstract

Influenza and pertussis prevention in young infants requires immunizing pregnant women and all caregivers (cocooning). We evaluated the knowledge and attitude of postpartum women about these two recommendations. A survey of predominantly Hispanic, underinsured, medically underserved postpartum women in Houston, Texas was performed during June 2010 through July 2012. Five hundred eleven postpartum women [mean age 28.8 y (18-45); 94% Hispanic] with a mean of 3 children (1-12) participated. Ninety-one (17.8%) were first-time mothers. Four hundred ninety-six (97.1%) received prenatal care; care was delayed in 24.3%. Only 313 (61.3%) received vaccine education while pregnant, and 291 (57%) were immunized. Four hundred seventy-four women (93%) were willing to be immunized during pregnancy if recommended by their healthcare provider, (the most trusted information source for 62%). Immunization of infants or infant caregivers had been discussed with 41% and 10% of mothers, respectively. Two hundred thirty women (45%) had received influenza vaccine; most intended to (79%) or had already received (15%) tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. Preferred locations for cocooning were hospital or community clinics (97%). Insufficient knowledge (46.6%), cost (31.4%), lack of transportation (26%), work commitments (13.3%), and fear of needles (13.3%) were perceived barriers to cocooning. Level of formal education received by mothers had no effect on the quantity or quality of immunization education received during PNC or their attitude toward immunization. Immunization during pregnancy and cocooning, if recommended by providers, are acceptable in this high-risk population. Healthcare providers, as reported in infant studies, have the greatest influence on vaccine acceptance by pregnant and postpartum women.

Pertussis vaccination in pregnancy

“…Studies show that 78% to 93% of pregnant or postpartum women say they would receive a vaccine recommended by their provider, regardless of influence from other sources such as family, friends or online resources. [83][84][85][86][87][88][89] Numerous studies have evaluated the attitudes of pregnant and postpartum women toward maternal immunization. Although some cultural differences exist, themes are emerging.…”

“…Maternal attitudes are remarkably consistent; their primary concern is that the vaccine is safe both for them and their baby, and they desire sufficient discussion with their provider to explain the rationale behind immunization. 83,84,[86][87][88][89] The benefits of and likely acceptance by pregnant women of pertussis vaccination has resulted in strong statements in support from organizations such as the American College of Obstetricians and Gynecologists, along with resources such as the Tdap toolkit, which provides literature and talking points for providers. 90,91 While these interventions have not as yet been translated into robust uptake rates, at least at a national level in the US, they address some of the provider level barriers.…”

Improving rates of maternal immunization: Challenges and opportunities

“…47,50 The desire to protect the fetus/infant and oneself from disease was a strong predictor of immunization. 22,23,29,34,42,46,55,56 Most consistently, having the vaccine recommended AND offered by their healthcare provider [21][22][23]25,28,29,[31][32][33][34][37][38][39][40]42,45,46,50,[54][55][56][57][58][59][60] and trusting the recommendations 47 were identified most frequently as important in increasing vaccine uptake. For influenza vaccine, prior vaccination of oneself 25,28,34,45,46,53,60 or one's partner 59 in previous years was a strong predictor of acceptance of vaccination during pregnancy.…”

Increased awareness and health care provider endorsement is required to encourage pregnant women to be vaccinated

“…Surveys of pregnant women have identified a number of factors associated with increased likelihood of immunization including prior vaccination status, 16,18 knowledge of vaccines and the diseases they prevent, 16,[19][20][21] perceived susceptibility to vaccine preventable illnesses 15,16,19 and healthcare provider (HCP) recommendation. [21][22][23] Lack of trust in vaccine information 19,24 and in the safety and effectiveness of vaccines are factors associated with reduced likelihood of maternal immunization during pregnancy. 23,24 These factors align with what is known about parental decision-making for childhood immunization 25 and the decision-making process adults undertake on their own behalf about vaccination.…”